I had the opportunity to return to Ecuador with the Sisters of Charity of Seton Hill, July 21-29. It was the third summer integration experience for Sisters from the Korean and U.S. provinces, visiting and volunteering with four Korean SCs who are on mission in Pedro Carbo, a small town about an hour and a half away from Guayaquil. Tracy Kemme, an Affiliate with the Sisters of Charity of Cincinnati, and I served as Spanish translators for the group as well as participants in the service activities they had planned. I also offered some basic medical services at the school for children with special needs and for some home-bound patients.
Crossing cultures is an adventure out of the comfort zones we usually inhabit. Starting with language, we were back and forth between English, Korean and Spanish 24/7. Morning and evening prayers were in English and Korean with an occasional hymn in Spanish. We all experienced similar frustration to some degree as only two sisters were able to communicate at a basic level in all three languages. Many times I found myself at a loss for words, using gestures, speaking as slowly and simply as possible, and finally seeking out one of the bilingual sisters to rescue me.As I have come to realize after thirty years in the southwestern U.S. and Mexico, the desire to build relationships is a powerful incentive to learn to speak a foreign tongue!
There were many ways I felt the ground unsettled beneath me during the week, and I am not referring to the bone-rattling adventures via moto-taxi or even the cross-country jaunt to a remote village for a day of service. Having plans change by the minute, waiting for scheduled events to begin, realizing the need to move to the rhythm of a music different than my own…this is all part of crossing cultures. It’s about learning to receive “the other”.
My metaphor for the Ecuador experience this year came midway through the week. We were just starting evening prayer when Sister He Chun, the director of nurses for the 24 hr clinic the sisters administer, got a call from downstairs. (The convent sits atop the clinic.) I was sitting next to her and when she came back from the phone she leaned over and said, “C-section. Do you receive babies?” I knew from last year’s visit that the clinic offered maternity services and that in case a cesarean was needed the obstetrician came from Guayaquil. He was on the way but there was no pediatrician available and so He Chun had been called to attend to the newborn. “Do you receive babies?” she asked me. Once upon a time…more than twenty years ago! I told her as much and said that I thought it would probably be better for her to attend the delivery since she knew the procedures for the clinic. As we continued evening prayer I found myself interceding for the mother, the baby waiting to be born, and for the entire health care team, asking St. Elizabeth Ann Seton and Our Lady of Guadalupe to be especially close at hand. And then came an irritating little voice within: “What are you praying for? You have the training to do this! God uses us to answer our own prayers.” The ground started to move beneath me. Despite my best efforts to say, “Don’t send me!” I realized that I was obviously the one called to serve in this situation. At the end of the prayer Sister He Chun said, “We go.”
First stop: the pre-op room where we found the patient laying on the stretcher with an intravenous drip running. She was smiling and happy, not having any obvious problems. I was introduced as “la doctora” who would be taking care of her baby. This was my chance to get a little history and I was relieved to hear that the reason for the surgery was because she had not dilated past 2 cm. It was her first pregnancy and she was at term. She said she didn’t think her bag of waters had broken and the baby was moving well. Another sigh of relief from me. I examined her and was happy to see that the baby was coming head-first and the size was appropriate. On to the dressing room where He Chun provided me with scrubs. I slipped shoe covers over my flip-flops and then she handed me a cloth cap. I had never used anything but disposable shower-cap type head coverings for surgery so I watched how she put on her own over her Seton Hill SC cap, hoping not to look too stupid!
Next stop: the “nursery”. On the clinic tour I had seen the row of wooden infant beds, each warmed by a light that looked like something used in a cafeteria serving line. There was also a more state-of-the-art radiant warmer bed but it was not prepared for use because “it is delicate”. Okay, back to the serving line. There was a little suction machine but we had some difficulty hooking up the baby-sized tubing to the equipment. No soft bulb suction? No. And oxygen? A big tank was next to the warmer bed and He Chun struggled to get the valve opened so that we could try it out with the ambu-bag. It didn’t quite connect with the bag so I said we would just have it ready to “blow by” the baby’s nose if needed. Oh, please don’t let us need it!
Now to the washroom where the obstetrician was scrubbing. Again, Sister He Chun managed the introductions, saying that we had no pediatrician but that I was a Sister/doctor from the States and would be receiving the baby. I said that it had been some years since I had attended deliveries but that hopefully it was like riding a bicycle…He seemed satisfied with that and happy for the help. I asked He Chun if there was an anesthesiologist and she opened the door to the O.R. to introduce me to him. Something didn’t seem quite right. The surgeon was still scrubbing and the clinic doctor had arrive to assist. Then I realized that the patient had already received general anesthesia! So mommy- and baby- were already asleep which meant that there might be need for more of a resuscitation than we were prepared for.
I said my prayers as I washed my hands and struggled to put on the sterile gown and gloves in the O.R. My only equipment was a surgical towel that the obstetrician indicated was for me to receive the baby. Everything was silent as the surgery began. It seemed like it took forever to carefully work through the abdominal layers to the uterus. When the doctor finally incised the uterus and then the amniotic sac, I was relieved to see that the fluid was clear. As he struggled to get the baby’s head out of the pelvis and then out of the uterus, I eyed the big suction hose that was the only device available. Oh, for a little blue suction bulb! After much tugging and pushing, the well-molded head was delivered, followed quickly by the body. The baby gave a gurgling cry, the cord was clamped and cut, and the infant was tossed into my waiting arms. “A big boy,” the surgeon said.
He Chun and I hurried out of the O.R., through the scrub room, and down the corridor to the nursery where finally I had a chance to begin assessing the baby. In my mind I was running through the Apgar routine- at one minute after birth and again at five minutes- as I dried off the baby who was now, thank God, crying vigorously. I was handed a cord clamp and Vitamin K and antibiotic eye drops. Wait! Can I have a stethoscope first? Stethoscope??? There was no stethoscope. What time is it? Are we at the five minute mark yet? Is there a clock in this room? No. A stethoscope arrived from somewhere and I did a very minimal exam. Then the Vitamin K and the eye drops. Then the various measurements. Then we dressed the baby, swaddled him in a blanket and placed him under the warming light.
“Now you tell the doctor the baby is good,” He Chun said. The baby is good. We changed our clothes and as we headed back upstairs I asked, “Who stays with the baby?” Oh, sometimes the family comes…The ground shook under me again as I thought of that new little being, all alone under that bright warming lamp and the new mother still under anesthesia in the O.R.
We arrived upstairs just as the others were finishing supper. There was a flurry of excitement. What was it? A boy? a girl? Is the mother okay? I had no words. I felt disoriented and somewhat shocked at what I had experienced. I was extremely grateful and relieved, but I had a strong sensation that I had just passed through some kind of time-travel. Back to my life as a physician in Santa Fe, NM but with feelings I had experienced as a student and resident during rotations in St. Lucia, West Indies. Yet I was here with my sisters, Korean and American, in Pedro Carbo, Ecuador. I felt as if I, too, had been delivered into waiting arms and was in need of a little resuscitation.
My experience in Ecuador called me to use gifts that I thought I had packed away. It pulled me back into a culture that is both familiar and frightening. As I reflect on this, I remember a conversation with my dear mentor, Sister Joseph Ignatius Owyang, SC, MD when she described her career transition out of clinical practice after 35 years as a pathologist at Good Samaritan Hospital in Cincinnati. I was a newly professed Sister of Charity and board-certified family physician in Santa Fe. She was a chaplain at St. Joseph Hospital in Albuquerque. What was it like for you? “Well, I wasn’t ready to make the move,” she said, “but God moved the earth under me. And here I am!” That is a perfect description of the Ecuador experience this year. And even though I am back in New Mexico I have a sense that God is still moving the earth under me.